Simkins Staff Daily Entry Form
1. Staff Member Completing Form *
2. Today's date *
3. Have you had contact (within 6 feet for at least 15 minutes) with someone who has been diagnosed with Covid 19 in the last 14 days? *
4. Has the health department or your healthcare provider been in contact with you and advised you to quarantine? *
5. Have you had any of these symptoms in the last 14 days? Please check all that apply. *
6. Since you were last at school are you awaiting test results OR have you been diagnosed with Covid 19? *
If your answers for questions 3, 4 or 6 were "yes" OR if you have any of the symptoms that were outlined in question 5, please plan to stay home and contact Zimmerman or Vaka to discuss.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy